直肠神经内分泌肿瘤的临床病理特点分析

目的 分析直肠神经内分泌肿瘤(NET)的临床和病理特点,以提高对该类疾病的诊治水平.方法 对62例直肠NET患者的资料进行回顾性分析,总结直肠NET的临床特点.根据组织学分化程度不同将直肠NET分为3种类型,探索肿瘤大小、组织学类型和转移的关系.结果 直肠NET临床表现不典型,以排便习惯改变为主占43例(69.4%),有10例(16.1%)无症状,9例在体检肛门指诊时发现.57例(91,9%)肿物距离肛缘8 cm以内.所有患者病灶均为单发,无类癌综合征表现.25.8%(16/62)的患者伴发结肠息肉,16.1%(10/62)的患者伴发结直肠腺癌.除10例伴发结直肠腺癌的患者外,其余52例中,肿瘤直径＜1 cm者39例,以l型为主,直径＞2 cm者7例,以Ⅱ型和Ⅲ型为主,直径＜1 cm、1～2 cm、＞2 cm各组发牛转移率分别为0、33.3%、71.4%.结论 直肠NET临床表现缺乏特异性,以单发为主,常无类癌综合征表现.肛门指诊是发现直肠NET最简单有效的方法,肠镜检杏对发现第二原发肿瘤和随访至关重要.

Analysis on clinical characteristics of rectal neuroendocrine tumors

Objective To analyze the clinicopathological characteristics of rectal neuroendocrine tumors (NETs) so as to improve their understanding and diagnosis. Methods The data of 62 rectal NETs patients were retrospectively analyzed to summarize their clinical characteristics. They were categorized into 3 types based on the level of histological differentiation. And the relationship of tumor size, histological type and metastases was examined. Results The clinical presentations of rectal NETs were atypical. The main clinical presentation was change in bowel habit (n = 43, 69.4%); Ten cases (16.1%) were asymptomatic. Nine cases were found during routine digital rectal examination. In 57 cases (91.9% ), the distance was within 8cm from anorectal line. All patients had single lesion without the presence of carcinoid syndrome. 25.8% ( 16/62 ) had colonic polyps while 16. 1% ( 10/62 ) synchronous colorectal adenocarcinomas. Except for synchronous colorectal adenocarcinomas (n = 10) , among 52 cases, there were 39 cases with tumor diameter ＜ 1 cm, the main type was type Ⅰ; 7 cases with tumor diameter ＞2 cm, the main types were types Ⅱ and Ⅲ. The metastatic rates in three groups with tumor diameter ＜ 1 cm, 1-2 cm and ＞2 cm were 0, 33.3% and 71.4% respectively. Conclusion The clinical presentations of rectal NETs are non-specific. Most cases are often single lesion without the presence of carcinoid syndrome. The clinical process and prognosis of rectal NETs are closely related to tumor size, histological type, the presence of lymph node metastases and liver metastases. The routine digital rectal examination is the simplest and most effectively way of diagnosing rectal NETs. Colonoscopy is important in diagnosing the synchronous cancers and conducting a follow-up.